The effectiveness of ERAS guidelines in reducing postoperative pain

Abstract

Background: Poorly controlled acute postsurgical pain can promote chronic opioid use and misuse long after the initial surgical procedure. Enhanced recovery after surgery (ERAS) guidelines have shown promise in reducing opioid exposure and minimizing opioid-related side effects. Aims:The aims of this evidence-based practice (EBP) project were to assess the ERAS literature to guide postoperative pain management practice change at an adult colorectal surgical unit, evaluate the practice change outcomes, and disseminate the findings.Methods: A Population, Intervention, Comparison, Outcome, and Time (PICOT) question was established to guide an ERAS literature search. Found articles were critically appraised using the FULD Critical Appraisal Tool. Following the critical appraisal, the steps of EBP were utilized to implement an ERAS guideline for adult colorectal surgical patients in a 281-bed medical center. Outcomes of the practice change were evaluated by comparing multimodal analgesic, regional anesthesia, and opioid pain medication use before and after guideline implementation.Results: Five articles were critically appraised for guideline development. After implementation, data demonstrated an increase in the use of multimodal analgesics and regional anesthesia and a decrease in the use of opioid pain medication. These findings were disseminated through multiple venues within the hospital, including a presentation to the stakeholders.Linking Evidence to Action: Evidence-based strategies to reduce postoperative pain are achievable while reducing perioperative opioid consumption. Engagement of key stakeholders and timely rollout of EBP changes are important for successful implementation. ERAS guidelines with a multimodal analgesia pathway are an effective way to reduce postoperative pain and perioperative opioid consumption.

Effectiveness of general anaesthesia with remimazolam tosilate on intraoperative haemodynamics and postoperative recovery: study protocol for a randomised, positive-controlled, pragmatic clinical trial (GARTH trial)

“…Enhanced recovery after surgery (ERAS) is a series of optimised perioperative treatments shown by evidence-based medicine to reduce surgical stress and perioperative complications, decrease length of hospital stay and hospitalisation costs and improve patient satisfaction and short-term and long-term postoperative recovery 1. Recently, many studies reported the effectiveness of ERAS across surgical procedures mainly evaluated by doctor-reported outcomes and length of hospital stay 2–4. However, new information is necessary for better uncovering the value of ERAS on patients receiving surgeries, such as the advance of anaesthetic drugs and the availability of implemented tool to assess patient-reported outcomes, as the ERAS Society guideline recommended 5 6.…”

“…1 Recently, many studies reported the effectiveness of ERAS across surgical procedures mainly evaluated by doctor-reported outcomes and length of hospital stay. [2][3][4] However, new information is necessary for better uncovering the value of ERAS on patients receiving surgeries, such as the advance of anaesthetic drugs and the availability of implemented tool to assess patient-reported outcomes, as the ERAS Society guideline recommended. 5 6 A variety of patient-reported outcomes, such as…”

Clinical efficacy and economic impact of an enhanced recovery after cardiac surgery program for early discharge

“…ese "fast-track'' programs were shown to reduce post-operative pain while reducing opioid consumption, decrease hospital stay, and improve overall patient satisfaction [2][3][4][5][6][7][8].…”